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History of the crush syndrome: from the earthquakes of Messina, Sicily 1909 to Spitak, Armenia 1988.

Man-made or massive natural disasters may be followed by 'epidemics' of the muscle crush syndrome. The first descriptions of the crush syndrome were in the German-language literature following the earthquake of Messina in 1909 and World War II. On the threshold of World War II, the English-language literature was still unaware of the crush syndrome. During the London Blitz in 1940, Bywaters clearly delineated the pathogenesis of the crush syndrome and established guidelines for the management of casualties. The experience from the war in southern Lebanon in 1982 showed that early volume repletion can prevent acute renal failure in casualties with the crush syndrome. Following the major earthquake at Spitak in 1988, massive international relief effort helped to rescue and salvage many casualties. International preparedness contingency plans will increase the survival of future casualties suffering from crush injury.

Armenia↗

Retinal vein occlusion in Armenia.

PURPOSE: To determine the demographic characteristics, associated ophthalmic and systemic conditions of retinal vein occlusion (RVO) and associations of central retinal vein occlusion among Armenian patients. METHODS: A retrospective study of 460 patients aged 30 years and older with a clinical diagnosis of RVO who were seen in the five-year period between January 1, 1993, and December 31, 1997 at the Eye Hospital. RESULTS: Signs of central RVO were found in 297 eyes (64.5%), branch RVO in 163 eyes (35.5%). Among the 460 patients occlusion was hemispheric in 4 eyes (2.4%), hemicentral in 5 eyes (3%). CRVO was more common among the younger patients (odds ratio [OR] = 2.42, 95% confidence interval [CI]: 1.06-5.65). Hypercoagulability was noted in the majority of RVO cases. Glaucoma was an associated condition (12.6%). Systemic hypertension was the most frequent association. In CRVO a significant association was found with hypertension (OR = 1.89, 95% CI: 1.23-2.70). CONCLUSIONS: Our results suggest RVO is associated with glaucoma and hypertension. RVO was more closely associated with hypertension than BRVO. There were no differences in the distribution for the site of occlusion with regard to sex in patients with CRVO and BRVO. No seasonal pattern was found in the onset of any type of RVO. Hypercoagulability may be a contributing factor in the pathogenesis. The findings reinforce recommendations to carefully evaluate patients with RVO for open-angle glaucoma, and to diagnose and treat systemic hypertension.

Adult↗

Assessment of the infectious diseases surveillance system of the Republic of Armenia: an example of surveillance in the Republics of the former Soviet Union.

BACKGROUND: Before 1991, the infectious diseases surveillance systems (IDSS) of the former Soviet Union (FSU) were centrally planned in Moscow. The dissolution of the FSU resulted in economic stresses on public health infrastructure. At the request of seven FSU Ministries of Health, we performed assessments of the IDSS designed to guide reform. The assessment of the Armenian infectious diseases surveillance system (AIDSS) is presented here as a prototype. DISCUSSION: We performed qualitative assessments using the Centers for Disease Control and Prevention (CDC) guidelines for evaluating surveillance systems. Until 1996, the AIDSS collected aggregate and case-based data on 64 infectious diseases. It collected information on diseases of low pathogenicity (e.g., pediculosis) and those with no public health intervention (e.g., infectious mononucleosis). The specificity was poor because of the lack of case definitions. Most cases were investigated using a lengthy, non-disease-specific case-report form Armenian public health officials analyzed data descriptively and reported data upward from the local to national level, with little feedback. Information was not shared across vertical programs. Reform should focus on enhancing usefulness, efficiency, and effectiveness by reducing the quantity of data collected and revising reporting procedures and information types; improving the quality, analyses, and use of data at different levels; reducing system operations costs; and improving communications to reporting sources. These recommendations are generalizable to other FSU republics. SUMMARY: The AIDSS was complex and sensitive, yet costly and inefficient. The flexibility, representativeness, and timeliness were good because of a comprehensive health-care system and compulsory reporting. Some data were questionable and some had no utility.

Armenia↗

Molecular study of FMF patients in Armenia.

Familial Mediterranean Fever (FMF, MIM 249100), or Periodic disease, is a recessively transmitted and ethnically restricted condition prevalent in population from the Mediterranean decent. FMF notoriously has been hard to diagnose until mutations in the MEFV gene have been identified and as a tremendous help are used for the diagnosis of difficult cases. Since FMF can be controlled by medication, it is extremely desirable to have a firm diagnosis. The aim of this study was to establish the frequency of the most common mutations and genotypes in Armenian population. Molecular analysis of MEFV gene mutations in 3000 Armenian patients has demonstrated direct correlation between the clinical severity and the molecular diagnostic criteria of the disease, including the development of renal amyloidosis with MEFV genotypes. MEFV genotyping performed in the framework of a genetic counseling may reveal and identify affected individuals in presymptomatic phase, providing the possibility of a precocious start of the therapy.

Adult↗

[General diagnostic center as a indicator of the problems of psychiatric service in Armenia].

The efforts directed to understanding of the role of genetic factors in both etiology and risk to develop Alzheimer's disease (AD) become more active. The results of such investigations should be used in genetic counseling with a caution. This counseling should be individual for each family. In respect to molecular genetic testing (and to some extent to diagnostic testing) we can't now do this work in most cases with sufficient accuracy, taking into consideration social, juridical, psychological, ethic and moral potential significance of such information. However, the data accumulated now about the role of a genetic factor in AD allow to perform a genetic assessment in certain cases by geneticists and the clinicians in specialized AD clinics.

Adolescent↗